title: A new treatment paradigm for trigeminal neuralgia using Botulinum toxin type A.
abstract: OBJECTIVE
  To review the current data for the use of Botulinum toxin type A (BoNT-A) in trigeminal neuralgia (TN) and to describe the preferred injection technique of BoNT-A in TN. To propose a new treatment paradigm for TN incorporating the use BoNT-A.
  
  
  METHODS
  MEDLINE and Google Scholar databases.
  
  
  METHODS
  The current data on BoNT-A for TN were reviewed and analyzed for outcomes.
  
  
  RESULTS
  Seven studies examining the use of BoNT-A were identified: Two randomized double-blind, placebo-controlled studies and five prospective case series. All studies found BoNT-A to be an effective treatment in the majority of patients; and the results of the two randomized double-blind placebo-controlled study showed significant benefit over placebo. The majority of studies used an intradermal or subcutaneous injection technique. The most common side effect was transient facial paresis.
  
  
  CONCLUSIONS
  BoNT-A offers a safe, effective, local treatment for TN that is nonablative in nature. BoNT-A should be considered in patients who have failed, become refractory to, or are unable to tolerate first-line pharmacologic treatments.
  
  
  METHODS
  N/A.
authors.affiliation: New York Center for Voice and Swallowing Disorders, St. Luke's-Roosevelt Hospital, New York, New York, U.S.A.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Guardiani
authors.forename: Babak
authors.initials: B
authors.lastname: Sadoughi
authors.forename: Andrew
authors.initials: A
authors.lastname: Blitzer
authors.forename: David
authors.initials: D
authors.lastname: Sirois
mesh_terms: D000465:Algorithms; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D014277:Trigeminal Neuralgia / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Facial pain; trigeminal neuralgia